Provider Demographics
NPI:1558146134
Name:BOYD, SHAWN (RN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 HAWTHORNE AVE # CLI
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3441
Mailing Address - Country:US
Mailing Address - Phone:914-375-8626
Mailing Address - Fax:914-992-9654
Practice Address - Street 1:463 HAWTHORNE AVE # CLI
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3441
Practice Address - Country:US
Practice Address - Phone:914-375-8626
Practice Address - Fax:914-992-9654
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627037163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice